Prostatic evaluation by transrectal sonography with histopathologic correlation: the echopenic appearance of early carcinoma

Fifty-two patients with clinical stage A and B carcinomas of the prostate were imaged by ultrasound (US) transrectally with a 5-MHz linear array transducer and transabdominally with a 3-MHz sector scanner prior to radical prostatectomy. The fresh specimens of 44 prostate glands were scanned in a water bath with a 5-MHz linear array transducer in multiple planes. In all cases, histopathologic correlation was obtained. Prostatic carcinoma presented as an echopenic lesion in 54% of the specimens, as a slightly hypoechoic area in 22%, and could not be identified in 24% because of its isoechoic characteristics. In contrast to many previous reports, no instance of echogenic cancer was observed.     

Bladder exstrophy-epispadias complex: prostatic evaluation by transrectal ultrasonography

Seven patients with bladder-exstrophy-epispadias complex underwent high resolution prostatic ultrasonography in order to establish the presence and appearance of their prostate gland and seminal vesicles. Six patients had been born with classic bladder exstrophy, and one patient with complete epispadias. The size of the prostate gland was in the normal range in three patients. Three patients had small glands, and in one patient no prostatic tissue could be identified. Two patients showed an unusual position or echoappearance of their glands. The seminal vesicles in five patients were relatively large, contained multiple cystic spaces, and/or extended posteriorly and inferiorly to the prostate gland proper. Our study demonstrates that the prostate gland and seminal vesicles are present in patients with bladder exstrophy. The unusual appearance, position, and size in most patients, however, suggests faulty embryologic development or changes secondary to surgery reflecting the complex nature of the condition. Likewise, the enlarged seminal vesicles may indicate impaired drainage of these structures secondary to the initial bladder closure or subsequent bladder neck reconstruction.     

Renal involvement in AIDS: sonographic-pathologic correlation

Renal sonography was performed in 36 patients with clinical and/or laboratory evidence of AIDS, usually because of deteriorating renal function. In 15 patients, histopathologic specimens were reviewed to characterize renal pathologic changes underlying the sonographic findings. Sonographic evaluation included determination of renal size and cortical echogenicity according to a standard grading system. Pathologic specimens were evaluated for tubular and glomerular abnormalities. Sonography showed either normal-sized or enlarged kidneys with grade I cortical echogenicity in 13 patients (36%), grade II in three patients (8%), and grade III in five patients (14%). Fifteen patients (42%) had normal renal echogenicity. In addition to focal segmental glomerulosclerosis the pathologic examination showed different degrees of tubular abnormalities. Striking, irregularly dilated, infolded tubules with flattened epithelium and intratubular deposits of proteinaceous material, and sometimes cystlike formation involving the medulla and cortex, were seen in two patients with grade III kidneys, and mild dilatation of the tubules was seen in four patients with grade I disease. Moderate tubular dilatation was observed in one patient with grade I disease. No significant tubular abnormality was seen in one patient with grade I disease or in seven patients with normal renal echogenicity. Although glomerular changes contribute to the increase in renal echogenicity, we postulate that the main factors responsible for the increased echogenicity in AIDS nephropathy are the striking tubular abnormalities seen in these patients.     

Determination of canine prostatic size in situ: comparison of direct caliper measurement with radiologic and transrectal ultrasonographic measurements

The use of transrectal ultrasonography to estimate canine prostatic size in situ was evaluated and compared to that of direct measurement via calipers and an in situ radiologic procedure. The length, width, and depth of prostates were measured by transrectal ultrasound in both the transverse and sagittal planes from which prostatic volume was calculated. Prostatic volumes were subsequently transformed into prostatic weights using the following nomogram: prostatic Weight (g) = 0.602 x prostatic Volume (cm3) + 1.16. Prostatic weights estimated by ultrasound as well as by direct measurement with caliper were similar (P greater than 0.10) to the true gravimetric weight; however, prostate weights estimated by the radiological X-ray procedure were significantly (P less than 0.01) lower. The relationship between true gravimetric prostate weight and that estimated by ultrasound was described by the following regression equation: estimated weight (g) = 1.127 gravimetric weight (g) - 1.665; r = 0.900; P less than 0.001; n = 23. In summary, the results of this study demonstrate that transrectal ultrasonography can be used to accurately predict canine prostatic weight.     

Update on prostatic ultrasound

Although there is good evidence that carcinomas of the prostate are usually seen as echopenic masses within the external zone of the prostate, it is unclear how often an echopenic mass has an origin other than carcinoma of the prostate. Technical problems at the periphery of the gland not uncommonly create echopenic areas on an artifactual basis. Whether ultrasound will prove to be a satisfactory screening method for the detection of carcinoma of the prostate is yet to be decided. Prospective studies are in progress, but it has not yet been established whether prostate screening is a worthwhile procedure. The best possible equipment is required to detect these subtle lesions; cheap equipment will probably not give adequate results.     

Ultrasonography of prostatic carcinoma employing amplitude-enveloped (AM) and frequency-demodulated (FM) imaging: in vivo, in vitro, and pathologic correlation

Thirty patients with biopsy proven carcinoma of the prostate were examined with transrectal (TR) (5-MHz linear array transducer) and transabdominal (TA) (3-MHz sector scanner) ultrasonography prior to prostatectomy. All patients had clinical stage A (n = 5) or B (n = 25) disease. Following retropubic radical prostatectomy, in vitro waterbath studies of the resected specimens were performed obtaining both conventional amplitude-enveloped (AM) images and frequency-demodulated (FM) images. The ability of each imaging modality (TR, TA, AM, FM) to detect the cancerous lesion was determined, and in all cases correlation with pathology was obtained. Transabdominal suprapubic ultrasonography did not prove helpful in detecting early carcinoma. Longitudinally oriented linear array transrectal ultrasonography was positive in nearly two thirds of the patients. Insignificantly lower positive correlation with pathologic findings was obtained from in vitro AM images; the lesions were often better visualized on transverse than on longitudinal images. The highest correlation with pathology was obtained from the in vitro frequency-demodulated images.     

Successful shock-wave lithotripsy of bile duct stones using ultrasound guidance

Eighteen patients with 41 gallstones in the common bile duct, common hepatic, cystic, and intrahepatic ducts underwent shock-wave lithotripsy using the electrohydraulic Sonolith 3000 lithotripter. Lithotripsy was performed using ultrasound guidance alone under intravenous analgesia/sedation. All patients previously had failed stone extraction via retrograde endoscopy, T-tube, or cholecystostomy., Lithotripsy was performed according to an FDA-approved protocol allowing a maximum of two 2500 shock-wave treatments at a 48 hr interval. Following the final lithotripsy or cholangiographic evidence of stone fragmentation, residual fragments were removed via endoscopic or percutaneous route within 24–72 hr. Ultrasound localization of gallstones was aided by continous infusion of the common bile duct with saline solution. In 15 of the 18 patients, complete fragmentation of the stones was accomplished, two had minimal fragmentation, and one with an encysted stone had no fracturing. No serious complications were encountered. Overall nonsurgical stone-free success rate was 17 of 18 patients, indicating biliary duct stones can be successfully treated using an ultrasound-guided lithotripter and intravenous sedation alone.     

Update on prostatic ultrasound

Although there is good evidence that carcinomas of the prostate are usually seen as echopenic masses within the external zone of the prostate, it is unclear how often an echopenic mass has an origin other than carcinoma of the prostate. Technical problems at the periphery of the gland not uncommonly create echopenic areas on an artifactual basis. Whether ultrasound will prove to be a satisfactory screening method for the detection of carcinoma of the prostate is yet to be decided. Prospective studies are in progress, but it has not yet been established whether prostate screening is a worthwhile procedure. The best possible equipment is required to detect these subtle lesions; cheap equipment will probably not give adequate results.     

The echogenic focus in prostatic sonograms, with xeroradiographic and histopathologic correlation

The sonograms of 42 patients scanned before and after radical prostatectomy were reviewed, giving specific attention to echogenic foci. All patients had clinical stage A or B adenocarcinoma of the prostate. Comparison of the scans with xeroradiographic and histopathologic studies showed all echogenic foci, with or without acoustic shadowing, to represent prostatic calcifications. Calcifications were located in the central portion of the gland exclusively, either immediately adjacent to the urethra or at the margins of the "internal gland", separate from the peripheral location of small tumors. With carcinomatous spread toward the urethra, calculi were found surrounded by tumor. This was considered a result of secondary involvement rather than dystrophic tumor calcification. Prostatic calcifications seem unrelated to the development of adenocarcinoma but must be recognized to prevent erroneous interpretation.